Nikolopoulos Manolis, Godfrey Michelle A L, Wuntakal Rekha
Department of Gynaecological Oncology, Queen's Hospital, Barking Havering and Redbridge NHS Trust, London, UK.
Department of Gynaecological Oncology, Queen Alexandra Hospital, Cosham, UK.
Obstet Gynecol Sci. 2020 May;63(3):337-345. doi: 10.5468/ogs.2020.63.3.337. Epub 2020 Mar 24.
To assess the clinical efficacy of the levonorgestrel intrauterine system (LNG-IUS) in the treatment of early-stage endometrial cancer in elderly morbidly obese women, whose multiple co-morbidities made the standard surgical treatment too risky to undertake.
A retrospective review was conducted and case series reports were prepared of all women diagnosed with endometrial cancer, from April 2011 to December 2016 at the Queen's Hospital, London, to identify women unfit for surgery and treated with the LNG-IUS.
Out of 438 women with endometrial cancer, Eight women with early-stage endometrial cancer were deemed unfit for surgery and underwent treatment with the LNG-IUS. All had grade 1 endometrioid endometrial adenocarcinoma, radiologically staged as 1a. Four women died of their co-morbidities, not related to endometrial cancer. One of them had 68 months of progression-free survival before death due to co-morbidities. One patient required a hysterectomy after 32 months of treatment with LNG-IUS and oral progestogens due to heavy vaginal bleeding. Three women have continued the LNG-IUS treatment with no evidence of progressive disease symptoms till date at a mean follow-up of 35.7 months.
For women with multiple co-morbidities, the LNG-IUS offers an effective and safe treatment for early-stage, low-grade endometrial cancer, with no cases of symptomatic progression reported in our case series. In the frail and elderly, where the quality of life is of paramount importance, surgical treatment may not offer additional long-term survival benefits.
评估左炔诺孕酮宫内节育系统（LNG-IUS）治疗老年病态肥胖早期子宫内膜癌患者的临床疗效，这些患者存在多种合并症，使得标准手术治疗风险过高而无法进行。
进行回顾性研究，并撰写了2011年4月至2016年12月在伦敦女王医院诊断为子宫内膜癌的所有女性的病例系列报告，以确定不适合手术并接受LNG-IUS治疗的女性。
在438例子宫内膜癌女性中，8例早期子宫内膜癌女性被认为不适合手术，接受了LNG-IUS治疗。所有患者均为1级子宫内膜样腺癌，影像学分期为1a期。4名女性死于合并症，与子宫内膜癌无关。其中1名女性在因合并症死亡前有68个月的无进展生存期。1例患者在接受LNG-IUS和口服孕激素治疗32个月后，因大量阴道出血需要进行子宫切除术。3名女性继续接受LNG-IUS治疗，平均随访35.7个月，至今无疾病进展症状的证据。
对于有多种合并症的女性，LNG-IUS为早期、低级别子宫内膜癌提供了一种有效且安全的治疗方法，在我们的病例系列中未报告有症状进展的病例。在体弱和老年患者中，生活质量至关重要，手术治疗可能不会带来额外的长期生存益处。
